Human herpes virus-6 or epstein-barr virus infection and acute allograft rejection in pediatric kidney transplant recipients: greater risk for immunologically naive recipients

Wade, Andrew; McDonald, Alan T. J.; Acott, P. D.; Lee, S; Crocker, John F. S.

doi:10.1016/s0041-1345(98)00548-x

Cited by 23 publications

(13 citation statements)

References 15 publications

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“…Immunosuppression and the different treatments associated with transplantation may also enhance HHV‐6 and HHV‐7 replication [Acott et al, 2001], although there is no consensus concerning the correlation of transplantations with clinical manifestations [Brennan et al, 2000; Tong et al, 2000; Koukourgianni et al, 2009]. In infants and adults, HHV‐6 is associated with graft rejection, with the presence of viral antigens in the rejected kidney [Okuno et al, 1990; Yalcin et al, 1994; Wade et al, 1998]. However, these data have not been confirmed by other researchers [Yoshikawa et al, 1992; Razonable et al, 2005].…”

Section: Introductionmentioning

confidence: 99%

Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

Caïola¹,

Karras

Flandre

et al. 2012

Journal of Medical Virology

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Human herpesvirus-6 and -7 (HHV-6 and HHV-7) may lead to pathological manifestations in renal transplant recipients. The aim of this study was to investigate beta-herpesvirus infections in 50 adult kidney transplant recipients after transplantation to examine the effect, interactions, and pathogenic consequences of infection and the effect of immunosuppressive regimens and Human cytomegalovirus (HCMV) prophylaxis with VACV. Beta-herpesviruses loads in the blood of 50 adult kidney transplant recipients over a 6-month period after transplantation and 198 blood donors were determined using polymerase chain reaction. The rate of HHV-6 detection in peripheral mononuclear cells (PBMCs) was higher in patients with end-stage renal disease and during the posttransplantation follow-up than in healthy subjects (33% and 68% vs. 12%, respectively). The detection rate of HHV-7 in PBMCs was similar between patients, both before grafting and during the follow-up for transplant recipients (69% and 88%, respectively), and healthy subjects (78%), and correlated with the number of lymphocytes. HCMV in plasma was detected only in patients during the post-transplant period (24%). VACV prophylaxis had no negative effect on the replication of HHV-6 or HHV-7, and univariate analyses demonstrated associations between HHV-6 infection and acute graft rejection [Odds ratio (OR) ¼ 2.94, 95% confidence interval (CI), 1.05-8.2, P ¼ 0.04], and between HHV-7 infection and cholestasis [OR ¼ 2.61 (95% CI, 1.08-6.3), P ¼ 0.03]. Immunosuppressive regimens had no effect on beta-herpesviruses infections. This study revealed the differing behavior of HCMV, HHV-6, and HHV-7 in kidney transplant recipients, and confirmed the association of HHV-6 with graft rejection.J. Med. Virol. 84:450-456, 2012. KEY WORDS: human herpesvirus-6; human herpesvirus-7; human cytomegalovirus; viral load; renal transplantation; graft rejection; antiviral prophylaxis; immunosuppressive regimen INTRODUCTIONHuman herpesvirus-6 and -7 (HHV-6 and HHV-7) are related to the human cytomegalovirus (HCMV) [Lawrence et al., 1990]. After primary infection, which Abbreviations: HCMV, human cytomegalovirus; HHV-6, human herpesvirus-6; HHV-7, human herpesvirus-7; CNS, central nervous system; EqCop, number of viral genomic equivalent copies; PBMCs, peripheral blood mononuclear cells; VACV, valacyclovir. is primarily asymptomatic or associated with febrile illnesses including exanthema subitum, HHV-6 and HHV-7 remain latent in a majority of adults [Yamanishi et al., 1988;Hidaka et al., 1994]. In some cases, primary infection with HHV-6 may lead to serious illnesses, particularly meningoencephalitis and hepatitis [Asano et al., 1990;Yoshikawa and Asano, 2000]. HHV-6 reactivation may lead to pathological complications, particularly in immunocompromised individuals, whereas HHV-7 exhibits no opportunistic behavior [Boutolleau et al., 2003]. Thus, in solid-organ transplant recipients, the reactivation of HHV-6 is frequent and usually asymptomatic. However, clinical complications may occur, inclu...

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Section: Introductionmentioning

confidence: 99%

Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

Caïola¹,

Karras

Flandre

et al. 2012

Journal of Medical Virology

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“…However, a literature review showed that cases with serum HHV-6 reactivation were more frequently associated with renal dysfunction (20), and we suspected direct reactivation of HHV-6 in the impaired organ of our patient. In fact, previous reports demonstrated that HHV-6 can be directly reactivated in renal tubular cells (21), and tubulointerstitial nephritis can occur in patients with DIHS/ DRESS (22).…”

Section: Discussionmentioning

confidence: 99%

Reactivation of Human Herpes Virus-6 in the Renal Tissue of a Patient with Drug-induced Hypersensitivity Syndrome/Drug Rash with Eosinophilia and Systemic Symptoms (DIHS/DRESS)

et al. 2016

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A 74-year-old man who had been administered trimethoprim-sulfamethoxazole for three weeks suffered from drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms (DIHS/ DRESS). In the early stage of the clinical course, he developed renal dysfunction. A renal biopsy showed granulomatous tubulointerstitial nephritis accompanying the proliferation of human herpes virus (HHV)-6 in tubular epithelial cells. With corticosteroid therapy, the systemic rash and renal function gradually improved. The present patient is the second case of DIHS/DRESS demonstrating a possible reactivation of HHV-6 in the renal tissue. The clinical role of viral reactivation in DIHS/DRESS must be further elucidated.

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“…It has been speculated that HHV-6 infection in organ transplant recipients can indirectly lead to other complications, such as the induction of rejection episodes and coinfection with other microorganisms, such as CMV or fungi [3,4]. HHV-6 infection in bone marrow transplantation recipients has been associated with the graft versus host disease.…”

Section: Discussionmentioning

confidence: 99%

“…In immunosuppressed patients, infection with HHV-6 can be life-threatening due to severe complications, such as interstitial pneumonitis, encephalitis and marrow aplasia [2]. It has been speculated that HHV-6 infection in organ transplant recipients can indirectly lead to the induction of rejection episodes and coinfection with other viruses, such as cytomegalovirus (CMV) or fungi [3,4], as well as to other complications; for example, HHV-6 infection in bone marrow transplantation recipients has been associated with graft versus host disease.…”

Section: Introductionmentioning

confidence: 99%

HHV-6 infection in a pediatric kidney transplant patient

et al. 2009

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Human herpesvirus 6 (HHV-6) infection can induce unusual complications in transplant patients, such as interstitial pneumonitis, encephalitis and marrow aplasia. We describe the clinical course of HHV-6 infection in a girl with renal transplantation. She presented with diarrhea and poor feeding on day 36 post-transplantation (Tx), after a 5-day steroid pulse for clinical signs of acute rejection. A week later she developed fever and had elevated plasma creatinine and lactic dehydrogenase levels, but a physical examination did not reveal any anomalies with respect to suggest rash, pneumonitis, encephalitis or lymphadenopathy. Two weeks later, the patient developed anemia and leucopenia. HHV-6 was the only pathogen detected by the PCR assay of the serum and marrow aspiration. The patient had a successful recovery without specific treatment. This case report highlights the wide spectrum of complications resulting from HHV-6 infection in immunosuppressed patients.

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Human herpes virus-6 or epstein-barr virus infection and acute allograft rejection in pediatric kidney transplant recipients: greater risk for immunologically naive recipients

Cited by 23 publications

References 15 publications

Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

Confirmation of the low clinical effect of human herpesvirus‐6 and ‐7 infections after renal transplantation

Reactivation of Human Herpes Virus-6 in the Renal Tissue of a Patient with Drug-induced Hypersensitivity Syndrome/Drug Rash with Eosinophilia and Systemic Symptoms (DIHS/DRESS)

HHV-6 infection in a pediatric kidney transplant patient

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